Efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy.Methods A total of 140 patients,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were enrolled and randomly assigned to ropivacaine group (group R)and routine analgesia group (group C).Three-port laparoscopic procedure was carried out.Before inserting trocars,incision infiltration was performed with ropivacaine with a total volume of 16 ml,6 ml for epigastric port,6 ml for umbilical port and 4 ml for working port.The equal volume of normal saline was given instead of ropivacaine in group C.Parecoxib 40 mg was intravenously injected before surgery in both groups or after surgery as rescue analgesic when necessary.The requirement for rescue analgesia was recorded within 24 and 48 h after surgery.The visual analogue scale (VAS) scores at rest and during activity were recorded at 2,4,6,8,12,18,24 and 48 h after surgery,and the area under curve (AUC) of VAS scores was calculated in each time point after surgery.The development of no pain at rest was recorded at 24 h after surgery.Parents'satisfaction with analgesia was assessed and scored at 24 and 48 h after surgery.Wound healing was evaluated and scored at 48 h after surgery,and the development of poor wound healing was recorded.The development of chronic pain and VAS scores were recorded at day 90 after surgery.Results There were 130 patients who completed the study,with 66 cases in group R and 64 cases in group C.Compared with group C,the AUC of VAS scores at rest in 0-8 h and 0-24 h periods after surgery was significantly decreased,the AUC of VAS scores at rest in 0-6 h,0-8 h,0-12 h,0-24 and 0-48 h periods after surgery was decreased,the requirement for rescue analgesia was reduced at 24 h after surgery,satisfaction scores were increased (P＜0.05),and no significant change was found in the rate of no pain at rest after surgery,wound healing score,incidence of poor wound healing,incidence of chronic pain at day 90 after surgery or VAS score at day 90 after surgery in group R (P＞0.05).Conclusion Incision infiltration with ropivacaine before incision can effectively alleviate acute pain within 48 h after laparoscopic cholecystectomy with a higher safety and exerts no effect on chronic pain after surgery.